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Nagu TJ, Aboud S, Matee MI, Maeurer MJ, Fawzi WW, Mugusi F. Effects of isoniazid resistance on TB treatment outcomes under programmatic conditions in a high-TB and -HIV setting: a prospective multicentre study. J Antimicrob Chemother 2017; 72:876-881. [PMID: 27999054 DOI: 10.1093/jac/dkw503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/25/2016] [Indexed: 12/11/2022] Open
Abstract
Objectives The scale and impact of background isoniazid resistance in TB- and HIV-endemic countries requires definition to improve treatment success and guide the scale-up of isoniazid preventive therapy (IPT). We describe the effects of isoniazid resistance on TB treatment outcomes among patients with or without HIV infection in Dar es Salaam, Tanzania. Methods A multicentre, prospective observational study was conducted among TB patients commencing WHO-recommended first-line TB treatment. In multivariate analysis we ascertained the relationship between isoniazid resistance at presentation with a composite of poor treatment outcomes (death, failure or default from TB therapy). Results Of 861 patients, 250 (29.0%) were HIV infected and 23 (2.7%) had isoniazid resistance. Seven hundred and ninety-seven (92.6%) of the patients were successfully treated and 25 (2.9%) died. Isoniazid resistance [relative risk (RR) = 6.0; 95% CI = 1.9-18.7; P < 0.01] and HIV infection with (RR = 2.3; 95% CI = 1.0-5.2; P = 0.05) or without (RR = 3.1; 95% CI = 1.5-6.2; P < 0.01) ART were independent predictors of poor treatment outcomes. Conclusions Background isoniazid resistance and HIV infection adversely affected TB treatment outcomes. Early laboratory detection of isoniazid resistance is important for successful TB therapy. Studies on the impact of background isoniazid resistance on the efficacy of isoniazid prophylaxis are recommended.
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Affiliation(s)
- Tumaini J Nagu
- Division of Therapeutic Immunology, Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Mecky I Matee
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Markus J Maeurer
- Division of Therapeutic Immunology, Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Parumasivam T, Leung SSY, Quan DH, Triccas JA, Britton WJ, Chan HK. Rifapentine-loaded PLGA microparticles for tuberculosis inhaled therapy: Preparation and in vitro aerosol characterization. Eur J Pharm Sci 2016; 88:1-11. [PMID: 27049049 DOI: 10.1016/j.ejps.2016.03.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/23/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
Abstract
Inhaled delivery of drugs incorporated into poly (lactic-co-glycolic acid) (PLGA) microparticles allows a sustained lung concentration and encourages phagocytosis by alveolar macrophages that harboring Mycobacterium tuberculosis. However, limited data are available on the effects of physicochemical properties of PLGA, including the monomer ratio (lactide:glycide) and molecular weight (MW) on the aerosol performance, macrophage uptake, and toxicity profile. The present study aims to address this knowledge gap, using PLGAs with monomer ratios of 50:50, 75:25 and 85:15, MW ranged 24 - 240kDa and an anti-tuberculosis (TB) drug, rifapentine. The PLGA-rifapentine powders were produced through a solution spray drying technique. The particles were spherical with a smooth surface and a volume median diameter around 2μm (span ~2). When the powders were dispersed using an Osmohaler(®) at 100L/min for 2.4s, the fine particle fraction (FPFtotal, wt.% particles in aerosol <5μm relative to the total recovered drug mass) was ranged between 52 and 57%, with no significant difference between the formulations. This result suggests that the monomer ratio and MW are not crucial parameters for the aerosol performance of PLGA. The phagocytosis analysis was performed using Thp-1 monocyte-derived macrophages. The highest rate of uptake was observed in PLGA 85:15 followed by 75:25 and 50:50 with about 90%, 80% and 70%, respectively phagocytosis over 4h of exposure. Furthermore, the cytotoxicity analysis on Thp-1 and human lung adenocarcinoma epithelial cells demonstrated that PLGA concentration up to 1.5mg/mL, regardless of the monomer composition and MW, were non-toxic. In conclusion, the monomer ratio and MW are not crucial in determining the aerosol performance and cytotoxicity profile of PLGA however, the particles with high lactide composition have a superior tendency for macrophage uptake.
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Affiliation(s)
- Thaigarajan Parumasivam
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, 2006 NSW, Australia
| | - Sharon S Y Leung
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, 2006 NSW, Australia
| | - Diana Huynh Quan
- Infectious Diseases and Immunology, Sydney Medical School, The University of Sydney, 2006 NSW, Australia
| | - Jamie A Triccas
- Infectious Diseases and Immunology, Sydney Medical School, The University of Sydney, 2006 NSW, Australia
| | - Warwick J Britton
- Infectious Diseases and Immunology, Sydney Medical School, The University of Sydney, 2006 NSW, Australia; Tuberculosis Research Program, Centenary Institute, Newtown 2042 NSW, Australia
| | - Hak-Kim Chan
- Advanced Drug Delivery Group, Faculty of Pharmacy, The University of Sydney, 2006 NSW, Australia.
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Porco TC, Oh P, Flood JM. Antituberculosis drug resistance acquired during treatment: an analysis of cases reported in California, 1994-2006. Clin Infect Dis 2012; 56:761-9. [PMID: 23223590 DOI: 10.1093/cid/cis989] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To inform efforts to prevent antituberculosis drug resistance acquired during treatment, particularly multidrug-resistant (MDR) tuberculosis, we analyzed surveillance records from the US state with the highest morbidity. METHODS Surveillance data from the California tuberculosis registry of cases reported between 1994 and 2006 were examined retrospectively. Crude risks of acquired resistance were estimated. Multivariate logistic regression was used to estimate odds ratios of demographic, clinical, and case management characteristics associated with acquired drug resistance (ADR), and secular trends in the incidence of ADR were assessed. RESULTS One in 688 patients acquired MDR tuberculosis, with crude risks varying greatly by initial drug susceptibility test results: 1 in 1909 if initially susceptible to isoniazid and rifampin, 1 in 113 if initially isoniazid resistant, and 1 in 23 if initially rifampicin resistant. Acquired isoniazid and rifampicin monoresistance occurred in 1 in 1018 and 1 in 1455 patients, respectively. Independent predictors of acquired MDR tuberculosis were initial isoniazid resistance (odds ratio [OR], 19.2; 95% confidence interval [CI], 8.25-44.7; P < .001), initial rifampicin resistance (OR, 35.9; 95% CI, 8.61-150; P < .001), human immunodeficiency virus (HIV) infection (OR, 5.07; 95% CI, 1.73-14.9; P = .003), and cavitary disease in the absence of directly observed therapy throughout therapy (OR, 2.65; 95% CI, 1.05-6.69; P = .04). The annual incidence of ADR declined over the study period. CONCLUSIONS Although ADR is rare and declining in California, its costly consequences warrant improvements in treatment practices. Our findings suggest that we ensure DOT throughout the course of therapy for patients with baseline drug resistance, cavitary disease, or HIV infection.
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Sergeev R, Colijn C, Murray M, Cohen T. Modeling the dynamic relationship between HIV and the risk of drug-resistant tuberculosis. Sci Transl Med 2012; 4:135ra67. [PMID: 22623743 PMCID: PMC3387814 DOI: 10.1126/scitranslmed.3003815] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The emergence of highly drug-resistant tuberculosis (TB) and interactions between TB and HIV epidemics pose serious challenges for TB control. Previous researchers have presented several hypotheses for why HIV-coinfected TB patients may suffer an increased risk of drug-resistant TB (DRTB) compared to other TB patients. Although some studies have found a positive association between an individual's HIV status and his or her subsequent risk of multidrug-resistant TB (MDRTB), the observed individual-level relationship between HIV and DRTB varies substantially among settings. Here, we develop a modeling framework to explore the effect of HIV on the dynamics of DRTB. The model captures the acquisition of resistance to important classes of TB drugs, imposes fitness costs associated with resistance-conferring mutations, and allows for subsequent restoration of fitness because of compensatory mutations. Despite uncertainty in several key parameters, we demonstrate epidemic behavior that is robust over a range of assumptions. Whereas HIV facilitates the emergence of MDRTB within a community over several decades, HIV-seropositive individuals presenting with TB may, counterintuitively, be at lower risk of drug-resistant TB at early stages of the co-epidemic. This situation arises because many individuals with incident HIV infection will already harbor latent Mycobacterium tuberculosis infection acquired at an earlier time when drug resistance was less prevalent. We find that the rise of HIV can increase the prevalence of MDRTB within populations even as it lowers the average fitness of circulating MDRTB strains compared to similar populations unaffected by HIV. Preferential social mixing among individuals with similar HIV status and lower average CD4 counts among HIV-seropositive individuals further increase the expected burden of MDRTB. This model suggests that the individual-level association between HIV and drug-resistant forms of TB is dynamic, and therefore, cross-sectional studies that do not report a positive individual-level association will not provide assurance that HIV does not exacerbate the burden of resistant TB in the community.
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Affiliation(s)
- Rinat Sergeev
- Department of Medicine, Brigham and Women's Hospital, 641 Huntington Ave, 02115, Boston, MA, USA
- Department of Microelectronics, Ioffe Institute, 26 Polytekhnicheskaya, St Petersburg 194021, Russia
| | - Caroline Colijn
- Department of Mathematics, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Megan Murray
- Department of Medicine, Brigham and Women's Hospital, 641 Huntington Ave, 02115, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, 641 Huntington Ave, 02115, Boston, MA, USA
| | - Ted Cohen
- Department of Medicine, Brigham and Women's Hospital, 641 Huntington Ave, 02115, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, 641 Huntington Ave, 02115, Boston, MA, USA
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Treatment outcomes and relapses of pulmonary tuberculosis in Lazio, Italy, 1999-2001: a six-year follow-up study. Int J Infect Dis 2008; 12:611-21. [PMID: 18395482 DOI: 10.1016/j.ijid.2007.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 12/09/2007] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The aim of this study was to enhance tuberculosis (TB) treatment outcome monitoring by linking diverse surveillance systems and estimating treatment outcomes including relapse. METHODS Tuberculosis treatment was surveyed in the Lazio region (Italy) from 1999 to 2001; a six-year follow-up of notified cases was undertaken to detect relapses. The results were analyzed as a population-based case-control study comparing each unsuccessful outcome and relapse with eligible controls. RESULTS Of the 974 patients who entered the survey, 805 (82.6%) had complete treatment evaluations; 398 (49.4%) had a successful outcome, 401 (49.8%) had an unsuccessful outcome, and six developed chronic TB. Death was associated with age >64 years (OR 5.9; 95% CI 3.1-11.2), male gender (OR 2.1; 95% CI 1.0-4.4), and using second-line drugs (OR 2.3; 95% CI 1.0-5.4). Treatment failure was associated with previous treatment (OR 3.0; 95% CI 1.4-6.7) and being male, being foreign born (OR 6.6; 95% CI 2.1-21.2), receiving second-line drugs (OR 7.4; 95% CI 1.8-29.5), and receiving modified therapy (OR 5.1; 95% CI 1.7-14.9). Relapses after successful outcomes were detected in 5.5%, for which the strongest predictor was having extrapulmonary lesions (OR 22.8; 95% CI 1.8-287.3). CONCLUSIONS Linking our survey data to other surveillance systems improved the mortality estimates and detected a high rate of relapse. Having received previous treatment and being a foreigner were independent determinants of treatment failure, suggesting that both acquired and primary drug resistance affect TB patients in Lazio.
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Shamputa IC, Jugheli L, Sadradze N, Willery E, Portaels F, Supply P, Rigouts L. Mixed infection and clonal representativeness of a single sputum sample in tuberculosis patients from a penitentiary hospital in Georgia. Respir Res 2006; 7:99. [PMID: 16846493 PMCID: PMC1538999 DOI: 10.1186/1465-9921-7-99] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 07/17/2006] [Indexed: 11/23/2022] Open
Abstract
Background Studies on recurrent tuberculosis (TB), TB molecular epidemiology and drug susceptibility testing rely on the analysis of one Mycobacterium tuberculosis isolate from a single sputum sample collected at different disease episodes. This scheme rests on the postulate that a culture of one sputum sample is homogeneous and representative of the total bacillary population in a patient. Methods We systematically analysed several pre-treatment isolates from each of 199 smear-positive male adult inmates admitted to a prison TB hospital by standard IS6110 DNA fingerprinting, followed by PCR typing based on multiple loci containing variable number of tandem repeats (VNTRs) on a subset of isolates. Drug susceptibility testing (DST) was performed on all isolates for isoniazid, rifampicin, streptomycin and ethambutol. Results We found mixed infection in 26 (13.1%) cases. In contrast, analysis of a single pre-treatment isolate per patient would have led to missed mixed infections in all or 14 of these 26 cases by using only standard DNA fingerprinting or the PCR multilocus-based method, respectively. Differences in DST among isolates from the same patient were observed in 10 cases, of which 6 were from patients with mixed infection. Conclusion These results suggest that the actual heterogeneity of the bacillary population in patients, especially in high TB incidence settings, may be frequently underestimated using current analytical schemes. These findings have therefore important implications for correct interpretation and evaluation of molecular epidemiology data and in treatment evaluations.
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Affiliation(s)
- Isdore C Shamputa
- Prince Leopold Institute of Tropical Medicine, Mycobacteriology Unit, Nationalestraat 155, B-2000 Antwerp, Belgium
- Tropical Diseases Research Centre, Microbiology Unit, P. O. Box 71769, Ndola, Zambia
| | - Levan Jugheli
- Prince Leopold Institute of Tropical Medicine, Mycobacteriology Unit, Nationalestraat 155, B-2000 Antwerp, Belgium
- International Committee of the Red Cross, 4, Kedia Str. 380054, Tbilisi, Georgia
| | - Nikoloz Sadradze
- International Committee of the Red Cross, 4, Kedia Str. 380054, Tbilisi, Georgia
| | - Eve Willery
- Laboratoire des Mécanismes Moléculaires de la Pathogenèse Bactérienne, INSERM U629, Institut de Biologie/Institut Pasteur de Lille, Lille, France
| | - Françoise Portaels
- Prince Leopold Institute of Tropical Medicine, Mycobacteriology Unit, Nationalestraat 155, B-2000 Antwerp, Belgium
| | - Philip Supply
- Laboratoire des Mécanismes Moléculaires de la Pathogenèse Bactérienne, INSERM U629, Institut de Biologie/Institut Pasteur de Lille, Lille, France
| | - Leen Rigouts
- Prince Leopold Institute of Tropical Medicine, Mycobacteriology Unit, Nationalestraat 155, B-2000 Antwerp, Belgium
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Daley CL. Molecular Epidemiology: A Tool for Understanding Control of Tuberculosis Transmission. Clin Chest Med 2005; 26:217-31, vi. [PMID: 15837107 DOI: 10.1016/j.ccm.2005.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
One of the primary goals of tuberculosis control programs is to interrupt the transmission of Mycobacterium tuberculosis. The development of several genotyping tools has allowed tracking of strains of M. tuberculosis as they spread through communities. Studies that have combined the use of genotyping with conventional epidemiologic investigation have increased the understanding of the transmission and pathogenesis of tuberculosis. This article reviews some of the lessons learned using these new epidemiologic tools.
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Affiliation(s)
- Charles L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Medical and Research Center, 1400 Jackson Street, Denver, CO 80206, USA.
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Praharaj AK, Kalghatgi AT, Varghese SJ, Nagendra A. Incidence and Drug Susceptibility pattern of Mycobacterium tuberculosis in HIV infected Patien. Med J Armed Forces India 2004; 60:134-6. [PMID: 27407606 PMCID: PMC4923034 DOI: 10.1016/s0377-1237(04)80103-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Incidence of HIV infection in patients with tuberculosis was found out by serological method (ELISA) with confirmation by Western Blot analysis. Out of 2116 tuberculosis patients tested for HIV, 150 cases were found to be positive for HIV infection (5.73%). Drug susceptibility to first line antitubercular drugs was carried out in 1378 isolates from HIV negative cases and 68 isolates from AIDS cases. The overall resistance pattern to one or more drugs was seen in 13.78% of isolates from HIV negative cases as compared to 7.2% isolates in AIDS cases. Multidrug resistance (MDR) was seen in 8.9% of isolates from HIV negative cases as compared to 4.4% of isolates from AIDS cases.
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Affiliation(s)
- A K Praharaj
- Senior Advisor (Pathology & Microbiology), 151 Base Hospital, C/o 99 APO
| | - A T Kalghatgi
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune - 411 040
| | - S J Varghese
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune - 411 040
| | - A Nagendra
- Professor and Head, Department of Microbiology, Armed Forces Medical College, Pune - 411 040
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Haddad N, Masselot M, Durand B. Molecular differentiation of Mycobacterium bovis isolates. Review of main techniques and applications. Res Vet Sci 2004; 76:1-18. [PMID: 14659724 DOI: 10.1016/s0034-5288(03)00078-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Until recently, none of the Mycobacterium bovis typing techniques permitted a satisfactory differentiation of isolates. During the last 10 years, the genome of pathogenic mycobacteria has been extensively studied, and phylogenetic analyses have shown that all (except Mycobacterium avium) belong to a single genetic species: the Mycobacterium tuberculosis complex. This increase in knowledge about the genome of these bacteria has lead to the discovery of molecular markers that allow us to differentiate isolates. Because of the phylogenetic proximity of the strains, even if most of these markers have been discovered in M. tuberculosis, they could be successfully adapted to the other bacteria of the M. tuberculosis complex, especially M. bovis. The most common markers in use today are the IS6110 insertion sequence, the direct repeat (DR) region, the poly(GC) rich (PGRS) sequences and the variable number tandem repeats (VNTR) sequences. The corresponding typing techniques are briefly described, and current knowledge of polymorphism and marker stability is detailed. If molecular markers are to offer wide perspectives for field studies, these two characteristics (polymorphism and stability) must be taken into account when choosing the marker(s) used in a study. In this context, examples of the application of molecular typing techniques for M. bovis are reviewed, on the one hand with epidemiological studies for which the major problem is the comparison between isolates and, on the other, with more general studies about the population genetics of M. bovis in a given country, and about its history and its phylogeny.
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Affiliation(s)
- Nadia Haddad
- Ecole Nationale Vétérinaire, U.P. Maladies Contagieuses, Maisons-Alfort, France.
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Sonnenberg P, Godfrey-Faussett P, Glynn JR, Shearer S, Murray J. Classification of drug-resistant tuberculosis. Lancet 2000; 356:1930-1; author reply 1932. [PMID: 11130408 DOI: 10.1016/s0140-6736(05)73482-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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